Saturday, October 29, 2011

The curse of being a veterinarian

It's kind of a joke in my field (and probably every field has their variation of this) - but veterinarians ALWAYS get the animals with the rare diseases, the congenital abnormalities, or the undiagnosable illnesses. Apparently, this extends to family members, as well.

A day or 2 after Evaline was born, my aunt called me about her 10+ year old Labrador/Great Dane mix. He was severely lethargic to the point where he would not rise. His breathing was labored, his gums were pale, he had severe bruising on his abdomen, and his extremities were cold. My aunt also noticed that his abdomen looked distended.

Any other Labrador with these symptoms would have a ruptured splenic or liver mass. It's as common as grass! I see at least 3 rupture splenic or liver tumors a month at work, and they are almost all Labradors or Golden retrievers. I recommended she get him to her veterinarian ASAP.

Dr W did a thorough exam on Flip and could not find evidence of a splenic or other abdominal mass. Flip's clotting times were abnormal, though. Given that Flip is an outdoor dog and because of the way the clotting times were elevated, the vet suspected rat poison and started treating accordingly. Initially, Flip responded and seemed to do well.

Then he started to deteriorate again and became severely, severely anemic. The veterinarian ordered packed red blood cells to give him a transfusion. When he rechecked the anemia a couple of days later, it had resolved! Flip seemed to be improving. He was discharged home, and he became lethargic again.

Further, he was now having trouble walking - as his back end was weak. He was almost walking on his elbow in one rear leg. The muscles were wasting away (atrophied), and he had developed a fever.

Last weekend, my aunt brought him to me to ultrasound his abdomen, looking for a culprit. I found nothing to explain his symptoms. He was still feverish. With no answers, I started him back on doxycycline (an antibiotic used to treat tick-borne disease such as Rocky Mountain spotted fever, Lyme, and Ehrlichia) and prednisone (a steroid).

His condition has not improved, and his atrophy has worsened in the rear limbs. I am going to euthanize him tomorrow at my aunt's house.

And still, I have no answers. I highly suspect some sort of cancer, but this could be tick-borne disease, autoimmune disease, or anything else. I am highly frustrated! I am a good veterinarian, and usually I at least have a handle on what is causing a patient's illness. In this case, I am left baffled.

Unfortunately, the veterinarian's curse strikes again - making me feel rather like a failure.

3 comments:

We had a dog with a ruptured splenic mass in the ICU at school this week so that is what I thought when I started reading your post. Then rodenticide (we had one of those as well). I'm sorry it turned out to be something different and that you can't figure it out. :(

The curse of the veterinarian also extends to the vet/vet student. I'm always being told my medical problems are 'complex.' We might have figured it out, but then again we might not have. I started IVIG on Thursday and am crossing my fingers.

was studying for one of my animal science classes and came across phosphorus poisoning...which sounded remarkably similar...not sure if that is still used as a rodenticide in your area...it even mentioned recovery followed by death within 48 hours due to liver failure...not exactly helpful i know...but i thought i would share just in case

DISCLAIMER

Any similarity between my stories and any person or animal, living or dead, is strictly a coincidence. Names, breeds, sexes, and details of the stories have been changed to protect the guilty and innocent alike.

About Me

I am an emergency veterinarian in North Carolina. Despite the crazy people I deal with, the awful cases of injured and sick animals, and the overall stress of emergency work, I absolutely love what I do. Happily married since I was 20, I have a wonderful husband who has a PhD in Mathematics, and a daughter around whom our world currently revolves. We also have a zoo living in our house that can be alternately wonderful and maddening. There are cats, parrots, and a dog who is very low on the totem pole. Our days are never dull and we are learning to balance the demands of work and family.
If you'd like to contact me: homelessparrot@gmail.com

Human gross-ness

Followers

Medical terminology

Lactate - a salt/ester of lactic acid that is produced as energy for a cell when oxygen levels are low. In critically ill animals, elevated lactate can be an indicator of inadequate blood flow to organs (perfusion), decreased delivery of oxygen, and/or decreased oxygen uptake. Values > 6-7 are usually considered to be poor prognostic indicators for survival.

GI sloughing: when the cells lining the GI tract die (can be secondary to MANY things, including heatstroke) with resulting bloody diarrhea, bacterial translocation into the bloodstream and sepsis

TTJ: transfer to jesus: code for when an animal needs to be euthanized or die

DIC: disseminated intravascular coagulation: a very, very bad thing - when the hemostatic system gets out of whack, and clots start forming in the blood vessels until all clotting factors are wasted. once those are gone, internal hemorrhage ensues, followed by death, usually. also known as "death is coming"

Pleural effusion - fluid contained in the pleural space (chest) - this is not the same as fluid in the lungs (see pulm edema) - in cats can be caused by infection in the chest, heart failure, cancer, FIP, feline leukemia, FIV, and in some cases, the cause is never found (idiopathic)

Anisocoria - unequal pupil size (related to any number of causes including brain damage/head trauma)

Sepsis - refers to a bacterial infection in the bloodstream or body tissues. This is a very broad term covering the presence of many types of microscopic disease-causing organisms.

Nephrectomy - kidney removal

Splenectomy - removal of spleen

Pulmonary edema - condition in which fluid accumulates in the lungs, usually because the heart's left ventricle does not pump adequately ( can be caused by heart failure, electrocution, drowning, too many IV fluids, to name a few)

Tick borne diseases - any of a myriad of diseases transmitted by ticks - including but not limited to Rocky Mtn Spotted fever, Lyme disease, Ehrlichia

Fine needle aspirate - A method of sampling in which a needle is used to suck in cells or tissue bits for diagnoses (good for diagnosing masses/lumps)

Blood glucose - The principal sugar produced by the body from food–especially carbohydrates, but also from proteins and fats; glucose is the body's major source of energy, is transported to cells via the circulation and used by cells in the presence of insulin (normal range in a dog/cat is 75-100)

Diseases I see/treat frequently

Dystocia - difficulty birthing. May be responsive to oxytocin administration (Pitocin, as in people) but may require c-section.

DKA - diabetic ketoacidosis: the extreme end of the diabetic scale. A patient that is diabetic can develop DKA when other diseases make the blood glucose hard to regulate. Other diseases that are commonly associated include urinary tract infection, pancreatitis, pyometra, skin infection, and cancer. In DKA, the body starts metabolizing fat and producing acids that cause a drop in blood pH, nausea, weakness, severe dehydration, electrolyte derangments, and death.

DCM - dilated cardiomyopathy: an idiopathic (cause unknown) cardiac disease in which the heart chambers become very thin/dilated, and cardiac output drops radically. Causes arrhythmias, tachycardia, and sudden death. Seen in large breed dogs like Dobermans, Great Danes, etc.

Lymphoma - cancer of the white blood cells, the most common and treatable form of cancer in dogs

Blocked cat - slang term for a male cat with a plug of mucus and crystals obstructing the urethra (fairly common in male cats) definitely a life-threatening because urine can't get out of the body! If present long enough, causes shock, acute renal failure, hyperkalemia (elevated potassium), coma, and death. Symptoms include straining in the litterbox, yowling while trying to urinate, producing small, bloody drops of urine (also symptoms of feline cystitis, a non-lethal condition)

GDV - stands for gastric-dilatation and volvulus - a condition of large breed, deep-chested dogs (usually) in which the stomach rotates 180 degrees on its axis and thus - nothing can enter or leave, considered the "mother of all emergencies" - it warrants immediate surgery and carries a guarded prognosis

IMHA - immune-mediated hemolytic anemia. A disease in which the immune system attacks the red blood cells and destroys them. It causes profound anemia and is life-threatening. Causes are primary (no known cause) and secondary ( tick borne disease, cancer, and heavy metal intoxication). Treatment is immunosuppression with drugs primarily. Prognosis is guarded at best.